Second Trimester Pregnancy Care — Weeks 13 to 28
The second trimester — weeks 13 through 28 — is often described as the most comfortable phase of pregnancy, but it is far from uneventful from a medical standpoint. It is the critical window for structural anomaly screening, chromosomal risk assessment, and early identification of conditions such as gestational diabetes, pre-eclampsia, and cervical incompetence. At Balaji Horizon Women’s Hospital, second trimester care is built around systematic, timed investigations that align with FOGSI and FIGO guidelines.
Anomaly Scan (TIFFA) — 18 to 22 Weeks
The Targeted Imaging for Fetal Anomalies (TIFFA) scan, also called the Level II or mid-pregnancy anomaly scan, is the most comprehensive fetal structural assessment in the antenatal programme. Performed between 18 and 22 weeks, it systematically evaluates all major fetal organ systems — brain and spine, face, heart (4-chamber and outflow tract views), lungs, abdominal organs, kidneys and bladder, limbs, and placenta. Placental location, amniotic fluid volume, and cervical length are also assessed. Our Fetal Medicine Unit performs TIFFA scans on Voluson E10 machines, with results discussed immediately with the patient.
Quadruple Marker Test — 15 to 22 Weeks
The Quadruple Marker (QM) test measures four maternal serum analytes — AFP, hCG, unconjugated estriol, and inhibin A — to calculate the risk of Down syndrome (Trisomy 21) and neural tube defects. It is an alternative or complement to first-trimester combined screening. Where the NT scan result was borderline or not performed, the QM test provides a second-trimester risk estimate. Abnormal results are discussed and, where indicated, referral for invasive testing (amniocentesis) is arranged with appropriate genetic counselling.
Gestational Diabetes Screening — 24 to 28 Weeks
Gestational diabetes (GDM) affects approximately 10–14% of pregnancies in India — one of the highest rates globally. Timely screening and management prevent macrosomia, shoulder dystocia, neonatal hypoglycaemia, and long-term metabolic risk for both mother and child. We screen all pregnant women with the 75g oral glucose tolerance test (OGTT) at 24–28 weeks using DIPSI or WHO/IADPSG diagnostic thresholds. High-risk women (family history of diabetes, prior GDM, obesity, PCOS) are screened earlier — at booking and again at 24–28 weeks.
Cervical Length Assessment and Pre-Term Birth Prevention
Cervical length measurement via transvaginal ultrasound at 18–24 weeks identifies women at risk of spontaneous preterm birth. A cervical length below 25 mm in a singleton pregnancy warrants further management including progesterone supplementation (vaginal micronised progesterone 200 mg nightly) and, in selected cases, cervical cerclage. Women with a history of second-trimester loss or prior preterm birth are monitored serially from 14 weeks onward.
Blood Pressure and Pre-Eclampsia Monitoring
Blood pressure is measured at every second trimester visit. A rise in blood pressure, onset of proteinuria, or abnormal uterine artery Doppler (elevated pulsatility index, notching) triggers accelerated monitoring and, where appropriate, initiation or adjustment of aspirin prophylaxis or antihypertensive therapy. Early identification of hypertensive disorders is critical — pre-eclampsia remains a leading cause of maternal and perinatal mortality globally.
Book your second trimester care: Call +91 +91 97234 31544 | Balaji Horizon Women’s Hospital, Science City Road, Ahmedabad.